Choices for treatment of hyperlipidaemia

A number of studies have established that lowering of serum cholesterol levels leads to striking reductions in cardiovascular events. Although children almost never experience myocardial infarction, stroke or coronary death, paediatric autopsy studies suggest that atherosclerosis starts in childhood. Moreover, the extent of atherosclerotic change in children can be correlated with the same risk factors, including serum cholesterol level, as identified in adults. As a result of these lines of evidence, the paediatric health care community has produced guidelines for treatment of children with hypercholesterolaemia, but has also debated the pros and cons of treatment. This controversy is unlikely to be resolved completely, because definitive studies would require several decades of follow-up and would raise serious ethical concerns. The purpose of this review is to summarize current views on the optimal approach to management of hyperlipidaemia in children, given current knowledge. We suggest that the child's sex, serum cholesterol level and family history of premature cardiovascular disease may be used to stratify risk. Children at exceptional high risk may be considered for pharmacological treatment.